We need to speak up against this bill - protect PA's and NP's

[ventana]

There is a movement in the RT (Radiology tech) world to have RA (Radiology Assistants) recognized by medicare and allowed to bill for their services.

 

This is in direct competition to every Radiology PA and NP out there

 

that however is not the worst of it

 

These "super techs" will be doing highly invasive procedures that are well out of the realm of technician roles - they have limited medical training and are not licensed to prescribe any type of medicines what so ever - not even an ASA or APAP never mind moderate sedation or any other type of meds

 

 

 

It would be great if you went to this web site and put in a few comments

 

ideas:

 

PA and NP are already meeting the need

PA and NP are trained as medical providers

PA and NP can manage the entire patient including any medications needed

 

RT's are an essential part of an Xray department but the are not medical providers and should not be doing invasive procedures - teamwork with RT and PA/NP is the best solution and it already in place

 

 

https://www.popvox.com/bills/us/112/hr3032/report#nation

 

 

we have something like 10,000 members - maybe we can get 1/10th that to respond.....

 

Even if you have NOTHING to do with Radiology would you want your mother or grandfather to get a painful invasive procedure from some one that was not trained as a medial provider and was unable to offer even a simple ativan?

[mkrumm]

Done.

 

Also: that is a great website. I'm going to try to check it regularly.

[joanna.nola]

I think it is interesting that they call themselves "midlevels" and "physician extenders" also. There organization is the Society of Radiology Physician Extenders (SRPE).

Here is their mission:

“The Society of Radiology Physician Extenders (SRPE) is a non-profit organization for the RPA and RRA sharing a common bond within the global mid-level radiology profession and medical community in general. The society holds an annual conference conducting seminars and presentations. The SRPE is an active participant with other health care professionals and organizations to educate and promote the role of the mid-level radiology extender. Our organization is committed to fostering the highest values and promoting superior lifelong success both personally and professionally.”

 

They clearly think they are highly trained for their jobs.

 

[h=1][/h]

[ToppDog]

Well, they are... it's just in a highly specialized area with little else to draw upon. I guess you could liken it to a nurse anesthetist in some ways.

[cosborn]

HR 3032 is job encroachment. If passed, it will stagnate Physician Assistants from advancing into this specialty. I know that most of you are not working in Radiology and may think why bother. But this is an important detail that needs to be addressed by all PAs.

 

If you are supportive of PA advancement throughout all areas of medicine, you need to speak up about this bill. The default position will be to pass HR 3032 unless we can speak up and mention ourselves as better candidates for the job, which we are. RAs/RPAs are not medical providers as they would have you believe. They cannot write drug orders and have limited abilities managing patients.

 

I have included a letter that opposes HR 3032. Please send it, or a version thereof, to your representative. PopVox is nice because you can login with your google, facebook, twitter, or linkedin account. Your comments are posted on the forum and a copy is sent to your Rep. It's simple and mindlessly easy. Here is the link and the letter:

 

https://www.popvox.com/bills/us/112/hr3032

 

November 26, 2012

 

Dear ******:

 

 

I am a Physician Assistant working in *Interventional Radiology* at *******. I am writing this letter in opposition to H.R. 3032, the Medicare Access to Radiology Care Act.

 

As you may know, my profession has become integral to our healthcare system, increasing access to patient care while containing cost. This has allowed us to become widely recognized, fulfilling roles in every field of medicine, including Radiology. In this specialty, I provide much needed services to patients in a timely matter as delegated by my supervising radiologist.

 

The Radiologist Assistants have conversely labeled their absence in the Radiology field as a ‘crisis’ to patient care. H.R. 3032 would amend the Social Security Act so they can receive Medicare reimbursement. Let me assure you that there is no ‘crisis’ and that this role is already being fulfilled by Physician Assistants, like myself.

 

My job duties, like the rest of the Radiology Physician Assistants across the country, match and exceed that of the proposed Radiologist Assistant. The names are very similar but our capabilities stand apart. At the delegation of a physician, physician assistants can perform procedures, manage patients, write drug orders, and interpret diagnostic tests. This is far beyond the scope of practice of a Radiologist Assistant.

 

Unnecessary redundancy should be avoided and the passage of H.R. 3032 would further complicate an already complicated healthcare system. What we need is not the addition of another ‘assistant’ or ‘allied health’ profession but focused expansions of the existing ones. Please consider opposing H.R. 3032, the Medicare Access to Radiology Care Act.

 

 

Sincerely,

[cosborn]

HR 3032 allows Radiologist Assistants to receive Medicare reimbursement for their services. This is job encroachment. If passed, it will stagnate Physician Assistants from advancing into this specialty. I know that most of you are not working in Radiology and may think why bother. But this is an important detail that needs to be addressed by all PAs.

 

If you are supportive of PA advancement throughout all areas of medicine, you need to speak up about this bill. The default position will be to pass HR 3032 unless we can speak up and mention ourselves as better candidates for the job, which we are. RAs/RPAs are not medical providers as they would have you believe. They cannot write drug orders and have limited abilities managing patients.

 

I have included a letter that opposes HR 3032. Please send it, or a version thereof, to your representative. PopVox is nice because you can login with your google, facebook, twitter, or linkedin account. Your comments are posted on the forum and a copy is sent to your Rep. It's simple and mindlessly easy. Here is the link and the letter:

 

https://www.popvox.com/bills/us/112/hr3032

 

November 26, 2012

 

Dear ******:

 

 

I am a Physician Assistant working in *Interventional Radiology* at *******. I am writing this letter in opposition to H.R. 3032, the Medicare Access to Radiology Care Act.

 

As you may know, my profession has become integral to our healthcare system, increasing access to patient care while containing cost. This has allowed us to become widely recognized, fulfilling roles in every field of medicine, including Radiology. In this specialty, I provide much needed services to patients in a timely matter as delegated by my supervising radiologist.

 

The Radiologist Assistants have conversely labeled their absence in the Radiology field as a ‘crisis’ to patient care. H.R. 3032 would amend the Social Security Act so they can receive Medicare reimbursement. Let me assure you that there is no ‘crisis’ and that this role is already being fulfilled by Physician Assistants, like myself.

 

My job duties, like the rest of the Radiology Physician Assistants across the country, match and exceed that of the proposed Radiologist Assistant. The names are very similar but our capabilities stand apart. At the delegation of a physician, physician assistants can perform procedures, manage patients, write drug orders, and interpret diagnostic tests. This is far beyond the scope of practice of a Radiologist Assistant.

 

Unnecessary redundancy should be avoided and the passage of H.R. 3032 would further complicate an already complicated healthcare system. What we need is not the addition of another ‘assistant’ or ‘allied health’ profession but focused expansions of the existing ones. Please consider opposing H.R. 3032, the Medicare Access to Radiology Care Act.

 

 

Sincerely,

[ventana]

This is not just for Radiology PA's - although it directly effects their jobs and the job market for Rad PA's (hint if you ever might want to try a great field give IR a try!)

 

If we coulg get just 10% of people to reply and post on the site it would be great - don't let "super tech's" take our jobs away!

[Kaepora]

Well, they are... it's just in a highly specialized area with little else to draw upon. I guess you could liken it to a nurse anesthetist in some ways.

 

^ what now?

[pacguy]

I applaud your enthusiasm and agree that we have a better understanding of medicine than the RA community. However, I believe that using a public format to discredit their profession could have negative implications. This path could have a slippery slope. Let me explain : We still have many states in which we are not legally allowed to use ionizing radiation. In order to change these state laws, we can't afford to have opposition from the RA or RT societies. Well, it just so happens that the American Society of Radiologic Technologists is a huge supporter of this RA bill HR3032. The ASRT is currently working on an exam in conjunction with the AAPA and the NCCPA to assure radiation minimal safety standards for Physician Assistants that want to utilize radiation in currently non-authorized states. This is a win win for us. It is an easy test to allow us to legally use radiation in states where we are already not allowed. My feat in going against HR3032 is that it also means going against the ASRT. We do not want to make the ASRT angry due to their clout at the state levels and being able to block future legislation for us regarding radiation usage. I would just be cautious when opposing this bill in such an open fashion.

[cosborn]

I do agree with you on one point. I think that it is wise for AAPA and the NCCPA to approach the ASRT with a negotiating presence rather than a challenging one. And I know that they would not endorse my opposition to HR 3032. In light of hopeful negotiations, they might actually want this billed to be passed.

 

However, an opposing voice still needs to be heard regarding this bill. It will take jobs from us. Politicians need to hear our side of the story or how else could they make an informed decision. I know that AAPA has their agenda and ways of doing things. That’s fine; that’s what I pay them to do. But, I have my own when it comes to my job and what I see as a burgeoning field for PAs. I still feel strongly toward my comment that started this thread. PAs should say something and I don’t see this as a slippery slope at all.

 

I feel that fluoroscopy will eventually be granted to us regardless of the ASRT’s position. Right now this is just a temporary hurdle. However, if HR 3032 passes we will have a permanent hurdle. It will mean competition between existing Radiology PAs and RA/RPAs along with permanently hindering PA growth into Radiology.

 

Many would say that we should tread lightly and have the ‘big boys’ hash things out, but I am not and encourage you to do the same. Grass-roots type activities have far more influence and freedom than established organizations. Make your voice heard.

[ToppDog]

I don't know. I can see both sides. While it sucks that this might encroach into PA turf, isn't that what a lot of other professions have been complaining about the PA profession?

[pacguy]

I will inquire with representation from NCCPA and ask their stance on this issue. I respect and trust their ideals. I will agree with what action they recommend. I do not want to injure any negotiations that may be in process. I think this topic is best left to our larger organizations anyway; especially this topic because radiology is such a very small piece of our pie.

[andersenpa]

So for us non-rads folks...

What is the crossover in duties between Rad PAs and RAs?

Will RAs be able to do interventional procedures?

Is there a need for the work that RAs do to ALSO require the diagnostic/treatment authority of a PA?

 

I can see some similarity between this issue and physician criticisim of PAs, so we should be careful of what we say about who is encroaching on territory and who is less qualified.

[pacguy]

I agree.....be careful and tread lightly on this topic or we may end up looking foolish. We are dealing with 3 large organizations here. As I looked farther into this, I found the American College of Radiology, American Registry of Radiologic Technologists and the American Society of Radiologic Technologists are major backers to this bill.

[cosborn]

Radiology PAs do solid organ biopsies, fluid collection drainages, venous catheter and filter insertions, lumbar punctures and moderate sedations. Alongside the procedures, we round, 1st assist on more complicated cases, do H&Ps, write drug orders, 'wet-read' studies.

 

With RAs, there is a tremendous amount of crossover. Although, as mentioned, our scope still far exceeds theirs. You may think, then, why ruffle feathers? Well, aside from a patient safety concern of having a tech do these procedures, this bill will give them 85% reimbursement. That is what we get reimbursed at! RAs cannot write drug orders or manage patients, but this bill will give them the same reimbursement rate as us? Maybe you haven't agreed with me so far, but you have to admit that this is a little irrational.

[brendan987]

Well, they are... it's just in a highly specialized area with little else to draw upon. I guess you could liken it to a nurse anesthetist in some ways.

 

Hey hey. Let's not say anything we can't take back now. Nurse anesthetists actually do a ton, at least that's the case for those in MN. I guess I cannot speak for other areas. I would say the closest comparison to this is a cardiovascular technician.

 

I have to agree with TopDogg a bit here. I know PA training is much more intensive than that for first assists, but PA's totally wiped them out of the market, and you know that they feel they were just as qualified to do what PA's do surgically.

[coloradopa]

There is no reason to tread carefully or negotiate. PAs are providers "RAs" are technicians. This is no different than OPAs or any number of hangers on that want to get paid for doing the procedure without doing the rest of the work. Medicare has always paid providers not technicians and thats the way it should be.

[LIPPER]

If allowed to perform invasive procedures and an adverse outcome arises what will they do? Yell "Help", then when they realize they can't do anything yell "Help" again? LOL

[NeoTrion]

To be honest I am surprised this is just now coming up. I graduated from a Radiology school 8 years ago, and they were training RA's (then called RPA's) from Weber State University in Utah. They basically started the program to pick up a shortfall in Radiologist when it came to active procedures and to also read studies. They had a fight with the ARRT because the ARRT didn't want anything to do with these then RPA's, but then saw the potential to regulate another type of certification and decided to crack down. They threatened any RT that went through Weber's program with the loss of their registry if they practiced as an RT. Eventually a deal was struck with the ARRT and the RA test was formed, which is why you see RA's now instead of RPA's. I remember talking to a Radiologist about changing the rules for billing 6 years ago and he commented that the "P" makes all the difference when it comes to billing. So now we are in the present, and the profession has progressed to this. I hate to tell you guys, but there is also a similar program doing the same thing for nuclear medicine in Arkansas that has been in existence for 4 or 5 years.

 

Your scope for RA or the nuclear side of things is whatever your radiologist feels comfortable with you doing. Some read just the normal films and present them, do fluro procedures, while others are pretty advanced. I have seen some that basically assist only and just read and present to the radiologist for approval vs others that are pretty independent. But they always work under a radiologist license and have no license of their own, so to be honest they would be more like advanced technologist or "super techs" as was stated earlier. Of course the education is centered mainly with radiology in mind, right down to the pathology, so naturally anything medical beyond radiology (like performing a good PE) is out of their reach education wise. All the RA's that I worked with could write orders in radiology, but they had to be cosigned by the radiologist before they left the department. If they were in Radiology then whatever they wanted was ordered under their radiologist (say an xray for line placement). With the current rules they are not allowed to do anything invasive without the radiologist in the department, and again it is the radiologist that decides what he/she can do independently. I know in Texas they are not allowed to even hit the fluro button for medicare patients (just like PA-C's), although there have been loop holes and grey areas found for RA's due to their RT status.

 

Personally I looked at both of these options and choose the PA-C route because I want to be able to have my own patient load and ability to get out of radiology. I feel the education I have gotten so far has made me far more well rounded than what I saw with the RA's. The only thing I do say is their is no substitution for experience. I think we can agree with the medics out there that this is the case. I spent a lot of time in just nuclear medicine alone, and I doubt many people in the PA world could touch me in that department, especially when it came to dosages of beta emitters for palliative treatment or other cancers. Even the radiologist refereed to us on these matters because nuclear wasn't something most radiologists new much about or wanted to learn. Pictures were one thing, but treatment was quite another. My point is that 9 times out of 10 a "super tech", at least in nuclear, will be more adept than a PA-C in these cases, hence the nuclear RA program. My personal feeling is that I would like to see a PA-C specialty exam in radiology or nuclear, but we are slow to adopt or even formally review a matter (ex. name change). In that case groups like this will eventually try to move in and take our place at the table while we figure out where we want to sit.

 

Just be aware that these people have been doing fluro, LP's, MRI, CT, and in some cases VI with radiologists for years in the trenches. In radiology they will almost always have the advantage of time and experience, just like Dr. Stead felt the medics did in our profession. I happen to agree with the forum on the issues of biopsies and some of the VI issues, but it would have been nice to have an organization that might have seen this issue more than 10 years ago. Just my .00000001 cents worth as a person and a member of both sides.

 

 

RT ® (CT) (MR) (N) ARRT

CNMT - NCT NMTCB

PA-S

[cosborn]

Thanks for your insight. It would be nice to have a specialty exam or even a post-grad fellowship in Radiology.

 

Even though the timing might be a tad late, please voice your comments to your Representative regarding HR 3032. Popvox makes it very very easy to do this.

[NeoTrion]

My guess is that this will be an uphill battle. I didn't know that the ACR was behind this as well. Between the ACR, ASRT, and ARRT that is pretty much radiology right there. If this gets radiologist backing, then it could be a done deal. I know they are saying ARRT has about 175 grand in membership on its own. But this still hasn't made it out of committee and if I am reading this right it was submitted last year?

[navyflyPAC]

Neo,

 

With all due respect, medics and corspmen are NOT the same thing as techs and that comparison is about as invalid as it gets. I was an infantry marine for many years and I've seen trauma response. It's quite different then running an MRI machine my friend.

[ToppDog]

Neo,

 

With all due respect, medics and corspmen are NOT the same thing as techs and that comparison is about as invalid as it gets. I was an infantry marine for many years and I've seen trauma response. It's quite different then running an MRI machine my friend.

 

You're completely wrong. It's a perfect analogy. Actually it's an even better one. Because of the specialization involved, a tech furthering training to become a more advanced tech makes more sense that military corpsmen becoming primary care providers, as the corpsmen's experience, while extensive, is not specialized & isolated to the same area of the advanced training. He never stated that they would become providers or be responding to trauma.

[navyflyPAC]

Have to disagree. Still not seeing it. But we're all entitled to an opinion. Also, it's a bit my fault as well for being a bit misleading. Citing trauma is just one extreme of their job.

Hospital Corpsmen are frequently the only medical care-giver available in many fleet or Marine units on extended deployment. In addition, Hospital Corpsman perform duties as assistants in the prevention and treatment of disease and injury and assist health care professionals in providing medical care to Sailors and their families. They may function as clinical or specialty technicians, medical administrative personnel and health care providers at medical treatment facilities. They also serve as battlefield corpsmen with the Marine Corps, rendering emergency medical treatment to include initial treatment in a combat environment. Qualified hospital corpsmen may be assigned the responsibility of independent duty aboard ships and submarines; Fleet Marine Force, SEAL and Seabee units, and at isolated duty stations where no medical officer is available.

 

Sorry, sometimes Wikipedia says it best. So, to counter what you just said, I believe they are extremely well suited to primary care. More so then an advanced "super tech" would be in performing invasive procedures which a RadPA can already perform. I do agree with what he says about the background being beneficial for someone like him and make him more qualified then a PA with no experience. But you have to be care when you start creating certain roles, it's a slippery slope.

[ToppDog]

I guess we're seeing different things in what he said. A tech getting addiitional training to become a more advanced tech is very similar to an EMT becoming a paramedic or an LPN becoming an RN. The word "assistant" seems to be causing confusion once again. I don't see them trying to act as providers.